Schildmeijer Kristina Görel Ingegerd, Unbeck Maria, Ekstedt Mirjam, Lindblad Marléne, Nilsson Lena
Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden.
BMJ Open. 2018 Jan 3;8(1):e019267. doi: 10.1136/bmjopen-2017-019267.
Home healthcare is an increasingly common part of healthcare. The patients are often aged, frail and have multiple diseases, and multiple caregivers are involved in their treatment. This study explores the origin, incidence, types and preventability of adverse events (AEs) that occur in patients receiving home healthcare.
A study using retrospective record review and trigger tool methodology.
Ten teams with experience of home healthcare from nine regions across Sweden reviewed home healthcare records in a two-stage procedure using 38 predefined triggers in four modules. A random sample of records from 600 patients (aged 18 years or older) receiving home healthcare during 2015 were reviewed.
The cumulative incidence of AEs found in patients receiving home healthcare; secondary measures were origin, types, severity of harm and preventability of the AEs.
The patients were aged 20-79 years, 280 men and 320 women. The review teams identified 356 AEs in 226 (37.7%; 95% CI 33.0 to 42.8) of the home healthcare records. Of these, 255 (71.6%; 95% CI 63.2 to 80.8) were assessed as being preventable, and most (246, 69.1%; 95% CI 60.9 to 78.2) required extra healthcare visits or led to a prolonged period of healthcare. Most of the AEs (271, 76.1%; 95% CI 67.5 to 85.6) originated in home healthcare; the rest were detected during home healthcare but were related to care outside home healthcare. The most common AEs were healthcare-associated infections, falls and pressure ulcers.
AEs in patients receiving home healthcare are common, mostly preventable and often cause temporary harm requiring extra healthcare resources. The most frequent types of AEs must be addressed and reduced through improvements in interprofessional collaboration. This is an important area for future studies.
居家医疗保健日益成为医疗保健的常见组成部分。患者往往年事已高、身体虚弱且患有多种疾病，治疗过程涉及多名护理人员。本研究探讨接受居家医疗保健的患者发生不良事件（AE）的起源、发生率、类型及可预防性。
一项采用回顾性记录审查和触发工具方法的研究。
来自瑞典九个地区的十个有居家医疗保健经验的团队分两个阶段审查居家医疗保健记录，使用四个模块中的38个预定义触发因素。对2015年期间接受居家医疗保健的600名（18岁及以上）患者的记录进行随机抽样审查。
接受居家医疗保健的患者中发现的不良事件的累积发生率；次要指标为不良事件的起源、类型及严重程度和可预防性。
患者年龄在20至79岁之间，男性280名，女性320名。审查团队在226份（37.7%；95%可信区间33.0至42.8）居家医疗保健记录中识别出356起不良事件。其中，255起（71.6%；95%可信区间63.2至80.8）被评估为可预防的，且大多数（246起，69.1%；95%可信区间60.9至78.2）需要额外的医疗就诊或导致医疗保健时间延长。大多数不良事件（271起，76.1%；95%可信区间67.5至85.6）起源于居家医疗保健；其余的是在居家医疗保健期间被发现，但与居家医疗保健之外的护理有关。最常见的不良事件是医疗相关感染、跌倒和压疮。
接受居家医疗保健的患者发生不良事件很常见，大多可预防，且常造成需要额外医疗资源的暂时性伤害。必须通过改善跨专业协作来处理和减少最常见的不良事件类型。这是未来研究的一个重要领域。
